Women's Health and the Debate over Mammography

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This issue of JNP is dedicated to women's health, something that most of us are involved in daily. Last November, the U.S. Preventive Services Task Force (USPSTF) made some surprising and controversial recommendations regarding screening mammograms. They changed the recommendation to note that screening mammograms should be done biennially for women 50 through 74; women under 50 should discuss their risk with “your doctor and make an informed decision…”

The USPSTF went a step farther and recommended against teaching and encouraging women to do breast self examinations (BSE). They continued, with “the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.” (See the recommendations at http://www.ahrq.gov/clinic/USpstf/uspsbrca.htm.)

In this issue of JNP, you will find an update on the controversy of the BSE and information about breast cancer follow-up. For decades we have stressed the importance of BSE, CBE, and screening mammograms for women. Several of my patients over 74 still want these examinations yearly, even though they may have to pay for the screen themselves. I have also found that, in my practice, the majority of women I have diagnosed with breast cancer were younger than 50 at the time of diagnosis; thankfully, they were a small number.

Another concern is that with this drastic change in the recommendations, insurances might decline to pay for mammograms for women under 50; and what about the breast cancer screening that we now have, and how will that factor into the picture? While each of us must assess our own feelings about the BSE and mammogram controversy, we also must have an honest discussion with our patients about these matters.